{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T13:38:15Z","timestamp":1780493895482,"version":"3.54.1"},"posted":{"date-parts":[[2024,12,5]]},"group-title":"Infectious Diseases (except HIV\/AIDS)","reference-count":15,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2024,12,5]],"date-time":"2024-12-05T00:00:00Z","timestamp":1733356800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.medrxiv.org\/about\/FAQ#license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2024,12,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:p>\n                  <jats:italic>Clostridioides difficile<\/jats:italic>\n                  is a leading cause of healthcare associated infection and an unacceptably high proportion of patients with\n                  <jats:italic>C. difficile<\/jats:italic>\n                  infection die despite conventional antibiotic treatment. Host-directed immunotherapy has been proposed as an ideal treatment modality for\n                  <jats:italic>C. difficile<\/jats:italic>\n                  infection to mitigate the underlying toxin-mediated pathogenic immune response while sparing protective gut microbes. Interleukin-23 monoclonal antibody inhibitors are used extensively to control pro-inflammatory Th17 immune pathways in psoriasis and inflammatory bowel disease that are similarly important during\n                  <jats:italic>C. difficile<\/jats:italic>\n                  infection. We used a large retrospective electronic health record database to test the hypothesis that hospitalized patients with\n                  <jats:italic>C. difficile<\/jats:italic>\n                  infection who are on anti-IL-23 treatment will have improved survival compared to patients without anti-IL-23. 9,301 anti-IL-23 patients had significantly lower probability of all-cause death within 30 days (0.54%) compared with 1:1 propensity-matched control patients (3.1%). IL-23 inhibition is a promising adjunct to\n                  <jats:italic>C. difficile<\/jats:italic>\n                  treatment and further clinical trials repositioning anti-IL-23 monoclonal antibodies from psoriasis and inflammatory bowel disease to\n                  <jats:italic>C. difficile<\/jats:italic>\n                  infection are warranted.\n                <\/jats:p>","DOI":"10.1101\/2024.12.03.24318323","type":"posted-content","created":{"date-parts":[[2024,12,5]],"date-time":"2024-12-05T18:35:19Z","timestamp":1733423719000},"source":"Crossref","is-referenced-by-count":1,"title":["Anti-Interleukin-23 Treatment Linked to Improved\n                  <i>Clostridioides difficile<\/i>\n                  Infection Survival"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5951-3156","authenticated-orcid":false,"given":"Gregory R.","family":"Madden","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2407-1087","authenticated-orcid":false,"given":"Robert","family":"Preissner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3672-0283","authenticated-orcid":false,"given":"Saskia","family":"Preissner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7268-1218","authenticated-orcid":false,"suffix":"Jr","given":"William A.","family":"Petri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2024120703403436000_2024.12.03.24318323v1.1","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1086\/655018","article-title":"Characteristics of Healthcare-Associated Infections Contributing to Unexpected In-Hospital Deaths","volume":"31","year":"2010","journal-title":"Infect Control Hosp Epidemiology"},{"key":"2024120703403436000_2024.12.03.24318323v1.2","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-023-08096-0"},{"key":"2024120703403436000_2024.12.03.24318323v1.3","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciab549"},{"key":"2024120703403436000_2024.12.03.24318323v1.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.immuni.2010.08.010"},{"key":"2024120703403436000_2024.12.03.24318323v1.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.chom.2019.03.003"},{"key":"2024120703403436000_2024.12.03.24318323v1.6","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jit277"},{"key":"2024120703403436000_2024.12.03.24318323v1.7","first-page":"e02386","article-title":"Inflammasome activation contributes to interleukin-23 production in response to Clostridium difficile","volume":"6","year":"2015","journal-title":"Mbio [Internet]"},{"key":"2024120703403436000_2024.12.03.24318323v1.8","first-page":"e00905","article-title":"Immune Profiling To Predict Outcome of Clostridioides difficile Infection","volume":"11","year":"2020","journal-title":"Mbio [Internet]"},{"key":"2024120703403436000_2024.12.03.24318323v1.9","doi-asserted-by":"crossref","first-page":"241","DOI":"10.3390\/toxins16060241","article-title":"Clostridioides difficile Toxins: Host Cell Interactions and Their Role in Disease Pathogenesis","volume":"16","year":"2024","journal-title":"Toxins"},{"key":"2024120703403436000_2024.12.03.24318323v1.10","doi-asserted-by":"crossref","first-page":"17562848231207280","DOI":"10.1177\/17562848231207280","article-title":"Inflammatory bowel disease and Clostridium difficile infection: clinical presentation, diagnosis, and management","volume":"16","year":"2023","journal-title":"Ther Adv Gastroenterol"},{"key":"2024120703403436000_2024.12.03.24318323v1.11","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1159\/000524199","article-title":"Adverse Effects of Anti-Interleukin-23 Agents Employed in Patients with Psoriasis: A Systematic Review","volume":"238","year":"2022","journal-title":"Dermatology"},{"key":"2024120703403436000_2024.12.03.24318323v1.12","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1910437"},{"key":"2024120703403436000_2024.12.03.24318323v1.13","doi-asserted-by":"publisher","DOI":"10.3201\/eid1810.120202"},{"key":"2024120703403436000_2024.12.03.24318323v1.14","first-page":"1010","article-title":"Accuracy of ICD-9 coding for Clostridium difficile infections: a retrospective cohort","volume":"135","year":"2006","journal-title":"Epidemiology Infect"},{"key":"2024120703403436000_2024.12.03.24318323v1.15","first-page":"e00092","article-title":"Novel Biomarkers, Including tcdB PCR Cycle Threshold, for Predicting Recurrent Clostridioides difficile Infection","volume":"91","year":"2023","journal-title":"Infect Immun"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1101\/2024.12.03.24318323","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T20:21:57Z","timestamp":1768508517000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.1101\/2024.12.03.24318323"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,5]]},"references-count":15,"URL":"https:\/\/doi.org\/10.1101\/2024.12.03.24318323","relation":{},"subject":[],"published":{"date-parts":[[2024,12,5]]},"subtype":"preprint"}}